Healthcare Provider Details

I. General information

NPI: 1124785423
Provider Name (Legal Business Name): KIMANI SERYBY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2021
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 FAULKNER ST UNIT 1202
DURHAM NC
27703-7406
US

IV. Provider business mailing address

5810 FAULKNER ST UNIT 1202
DURHAM NC
27703-7406
US

V. Phone/Fax

Practice location:
  • Phone: 336-264-0662
  • Fax:
Mailing address:
  • Phone: 336-264-0662
  • Fax: 833-406-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18719
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701010863
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: